Provider Demographics
NPI:1144757915
Name:IMRAN H CHOWDHURY MD PA
Entity Type:Organization
Organization Name:IMRAN H CHOWDHURY MD PA
Other - Org Name:INFECTIOUS DISEASE INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-997-7677
Mailing Address - Street 1:6510 KENILWORTH AVE
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:410-997-7677
Mailing Address - Fax:410-997-1636
Practice Address - Street 1:6510 KENILWORTH AVENUE
Practice Address - Street 2:SUITE 2500
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-9997
Practice Address - Country:US
Practice Address - Phone:240-770-6345
Practice Address - Fax:240-467-3993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFECTIOUS DISEASE CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409510300Medicaid